“Bad Pneumonia” in DNR Patient

“Room 4, old septic guy with pneumonia, a trach, DNR, admitted,” says your colleague as he hands over the department. “He’s really hypoxic, but we put in a new trach collar, sats are holding at 90%. I’ve talked with the family. He fell, so we’re getting a CT of the head and C-spine that still pending. Would you check it?”

“Sure,” you say, secretly grumbling a bit about the extra work. Your mild annoyance is quickly forgotten in the day’s opening barrage from the waiting area and EMS. A short while later, the daytime respiratory therapist on rounds remarks to you, “You know that trach guy isn’t breathing all that well, even on the O2”. “Try suctioning out the trach,” you reply. “I did,” she parries, “It’s no better.” You make a note to do a “fly-by” between new cases to check on this patient.

A short time later, the CTs are up for review, and you glance at the C-spine while sipping a second morning coffee. “Oh crap!” you say loud enough to stop all conversation in a 20-foot radius. Too much coffee. Deep breath. You turn to the clerk, and in a calm quiet voice say “Um, call respiratory and the nurse and have them meet me in Room 4.”